What’s The Episode About?
In this episode, I’ll be sharing why some women have high testosterone and what kind of havoc it can wreak on their system when it occurs. When it comes to testosterone levels in women, there’s a lot of confusion among women, and also among health professionals.
In fact, many health professionals don’t quite know what to do when a woman has elevated testosterone levels. Stay tuned as I explain why that happens by focusing on polycystic ovary syndrome and diabetes.
Key Points Discussed:
- The silent epidemic that is polycystic ovary syndrome (01:51)
- The kind of havoc high testosterone can wreak on the female body (03:42)
- The hormone dysregulation related to insulin that causes irregular periods (06:34)
- How well oral contraceptives work for hormone balancing (09:17)
- Teaching women to be self-advocates for themselves (12:58)
- Understanding the relationship between hormones, blood sugar and insulin, and vice versa (16:50)
Where Can You Learn More?
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When Was It Published?
October 30, 2019
Disclaimer: The Transcript Is Auto-Generated And May Contain Spelling And Grammar Errors
00:00 In today’s episode of The Optimal CEO Podcast, I’ll be sharing why some women have high testosterone and what kind of havoc it can wreak on their system when it occurs. So stay tuned to find out more.
00:14 Here at The Optimal CEO Podcast, we help CEO entrepreneurs who love taking ownership of their wellness journey, but because they know it’s their most prized investment and when their state of wellness is at its peak, their income source. We want to help relieve CEO entrepreneurs from the pressure of unnecessary health exposure so they can be highly focused on growing their business and physically optimize for the journey so they can enjoy getting there.
00:49 Hi, I’m Dr. Brian Brown, and I’d like to personally welcome you to today’s podcast episode. Thank you for joining me. So, when it comes to testosterone levels in women, there’s a lot of confusion among women, and also among health professionals. In fact, many health professionals don’t quite know what to do when a woman has elevated testosterone levels. In fact, if you poll most medical providers, they will tell you that sometimes that just happens, and it’s nothing to be concerned about. However, I’m going to be talking to you today about why this may occur, and what actually may be happening. In the female body, there are several reasons why testosterone can be elevated. One of those is polycystic ovary syndrome or PCOS. Another is diabetes, whether it be type one diabetes or type two diabetes, and also adrenal dysfunction or adrenal disease. In this segment, I’m going to actually be focusing a lot on the silent epidemic.
01:51 I call it PCOS or polycystic ovary syndrome. I’ll touch a little bit on diabetes because I’m talking about polycystic ovary syndrome, and you’ll see the link here in just a second, but I won’t be focusing much on adrenal disease. In medicine, they teach us to actually look for the horses, not the zebras. In other words, look for the more common issues versus the less common issues, because 90% of the time it’s going to be the more common issue. The problem that we have when it comes to looking at women with PCOS and understanding that one of the primary characteristics we’ll see it when we look at a laboratory profile when we draw blood on this person, is we’ll typically see high testosterone level, whether it be total testosterone or free testosterone, or high DHEA levels, or high DHT levels.
02:47 Any of those androgens can be out of balance, and you may have heard me speak previously when I was talking about DHEA in previous podcast episodes, about the link that if you see that elevated on routine lab work, that it could indicate that there’s something like PCOS going on. Now, the current thinking is that you need to have elevation in all of your androgens, meaning your testosterone, your DHT, and your DHEA. Nothing could be further from the truth. In fact, if you look at the European research, European research says it may be one or numerous androgens that are elevated, and in some cases, if you’ve got somebody that’s very physically fit, and they’re controlling their insulin very well, and I’ll explain the linkage here just a second. They may not have elevated androgens at all. Now, what happens when we see elevated testosterone or high testosterone?
03:42 In other words, what kind of havoc can it wreak on the female body in the system? Well, and one of the main things we see is a scalp, hair loss or hair thinning, even to the point of male pattern baldness. And I know that sounds strange that a female can have male pattern baldness, but male pattern baldness is typically because of testosterone. So if you start seeing those types of thinning right in the front, right above the forehead or on the crown of the head, that’s highly suspicious that there could be elevated testosterone going on. Another issue is excess body hair, whether it be dark hair on the arms, uh, dark hair even on the chest or the back or the face. It can be an issue, so it’s this dichotomy of thinning hair on top and excess body hair on the body. Those are signs of hot testosterone hair growth on the Chan.
04:36 Again, it’s that excess hair growth that we see or sideburns even, or the upper lip tends to be problematic for women as clinicians. We shouldn’t assume that there’s nothing going on if we don’t physically see that with our eyes, because let’s face it, with the advent of aesthetic clinics today, women can go and get that aesthetically taken care of with laser treatments and so on and so forth. So don’t just assume that there’s nothing going on. Ask. Have you had issues with this in the past? Another issue that we typically see with high testosterone is acne or persistent adult acne. Sometimes they can ebb and flow with the cycle. I’m not too terribly worried about that particular type of acne so much as I am cystic acne that occurs all the time. It may occur all the, it occurs all the time. It may or may not get worse during PMs, but acne is one of those big things.
05:33 All these skin, excessive oily skin may also be a sign that you have odd testosterone, agitation, aggression, irritability, mood swings significantly increased libido or hypersexuality and early stages of high testosterone may be a problem such as late teenage years or twenties and then when you start getting into your thirties you’ll actually see levels are still high, but the actually the libido is coming down. My thinking on that is having worked with a lot of younger women in their 20s I typically see that those and following them over time, I typically see that their testosterone levels are so, uh, they’re accustomed to having them so high in their twenties that when they get in their thirties and forties they’re still elevated, but there’s so much lower in comparison to where they were in their twenties that they start feeling this low in their libido. So to us, the testosterone is still high to them.
06:34 It’s not. Another thing with high testosterone is there can be irregular periods. You can skip periods, you can have extra periods, heavy periods, you can have clotting and you can have absence of periods. Why does this happen? Well, it happens because there’s a, there’s a hormone dysregulation that I’ll explain in just a second related to insulin. There can be increase in muscle mass, change in body shape, deepening of the voice or raspiness or hoarseness of the voice infertility. That’s generally not, it’s generally not associated with high testosterone, but it’s definitely a study associated with PCLs due to low progesterone. So if I’m seeing somebody with high androgen or high testosterone symptoms like acne, hair thinning, excess body hair, and that you’ve had a history of infertility. My suspicion for PCLs or polycystic ovary syndrome goes through the roof and increased risk for female cancers as well as diabetes, heart disease, stroke and obesity.
07:30 So high testosterone can definitely recall a lot of havoc. Now the problem we run into is that if a medical provider actually checks testosterone, they typically don’t check a D H E a S or the sulfate form and they typically don’t check free testosterone. It’s important to check all three of those. I don’t typically check a D H T because if DHT is elevated, there are going to be skin manifestations. In other words, you’re going to have hair thinning, excess hair growth on the body and or acne, so it’s very telltale in and of itself versus the total testosterone free testosterone and DTA needing to be checked, but quite frequently you’ll have a female pop into their general practitioner and the medical provider and they’ll, they’ll be telling their medical provider about the things that just aren’t quite right. They seem a little anxious and irritable.
08:22 They’re cramping really bad around the time of their period. Their periods are off and they’ve had these skin issues like acne and facial hair growth and things like that and it’s just mild but it’s bothersome to them. And then like I said, if a medical provider actually does check the correct levels and they see that they’re just a little bit elevated, there’s typically nothing happens because they’ll be on the high end of the normal range and are in that reference lab reference range. And I’ve talked about that numerous times in other podcasts of how that is not that accurate. You just need to know the ranges that women should fall in, and when you see them go beyond that, then it’s kind of something to pay attention to. But typically, either a, nothing will happen. Or B, you might have a medical provider say, Hey, you know, if the testosterone symptoms are bothering you that bad, why don’t we put you on a birth control pill?
09:17 Now, whatever your thoughts are on birth control pills, oral contraceptives for hormone balancing or not, it actually does work. It actually lowers testosterone and I see it used quite effectively. In fact, younger clients, I don’t treat many teenagers at all and I don’t treat many young 20 somethings. Usually, my clients are closer to 30 and above, but if they do or they are younger and they do have these symptoms, I will typically recommend a birth control pill. It tends to work really, really, really well. So let’s focus on polycystic ovary syndrome because this is one of the main reasons that we can typically see testosterone elevated. Now in the United States, PCO else has been recognized at a rate of about 3% of women of childbearing age. And childbearing age is a huge span of time. It’s from the time that a female starts having their period around age nine 10 1112 all the way up to menopause.
10:14 So it can run into the fifties for some people. So you can be of childbearing age during that time. And so that’s what I’m talking about when I say of childbearing age. So in the US about 3% of the population a couple of years ago, that got raised to about 5% so we were recognizing it a little bit better. But when you look at the European guidelines for diagnosing PCLs, which by the way, the rest of the world uses what we typically see a rate of close to 30% of women of childbearing age have had polycystic ovary syndrome. And now the crazy thing is that it boils down to diagnostic criteria. And there are a whole lot more symptoms on the diagnostic criteria list for the European guidelines than there are for the American guidelines. And that’s really sad because we miss a lot of people in a PCs is left untreated.
11:05 It can actually lead to type two diabetes and other complications related to type two diabetes such as lipid disorders, high cholesterol, heart conditions, heart attacks, stroke, so on, so forth. So we want to stay away from that. We want to identify it early and get on top of it early. So if we see these females in clinic that have high testosterone, a suspicion is very high that there are PCs going on. So the next thing you want to do is you want to look and see how much insulin resistance is there. And it’s a simple test by checking fasting blood sugar and fasting insulin and running the ratio on that. Typically I will say if a fasting insulin is over seven, it’s problematic anyway. Um, so that being said, you want that fasting insulin to be seven or under. And typically I’ll see women with PCLs that’ll have fasting insulins, 2025 35 45 50, sometimes 60 or 70 which is extremely high levels for insulin on a fasting patient.
12:05 So you want to pay really close attention to that, especially if their blood sugar is creeping up. And a lot of times women are, are so diligent, they’re much better than men at getting annual checkups done. And they typically have lab work that they’ve kept up with through the years. So you can look back at their lab, work on their annual female exams and see that their blood sugar when they were in their twenties was 76 when it was fasting. And then the closer they approached to 30, it’s going up to 91 92 and the closer they get to 35, it’s approaching a hundred or a little bit more. And because it doesn’t necessarily flag out as high, the clinician, uh, the medical provider doesn’t necessarily pick up on it and nobody ever checks fasting insulin. But very rarely do you ever see that done. And I will actually add a hemoglobin a one C which gives us a 90 day average of what that blood sugar is doing.
12:58 What I’m looking for is I’m looking to see how well that person is compensating for their elevations in blood sugar and elevations in insulin and I’m looking to see how insulin resistant they are. When we take the total picture of what their hormones are doing plus what their insulin status is like, we can then develop a picture of and say, yes, this person has PCLs when we combine it with their historical symptoms that they come in with. So we definitely want to take a really close look at these females that come in with elevated testosterone. We don’t need to, as we say in the in the field poopoo that because it’s something that could be detrimental in the long run. I’m so staying on top of it, get on top of it, but the best way I’ve learned to do that is to teach women to be self-advocates for themselves so that they can ask their provider, their medical provider if they’re having these high testosterone symptoms.
13:54 They can ask their medical providers, say, listen, would you check my D a T a S and it’s critical to put the S on the end of it, free testosterone and a total testosterone level and then see what those levels look like. If they’re elevated, then automatically a suspect insulin resistance, whether they have symptoms of high testosterone or not. So that’s it in a nutshell when it comes to high testosterone, it’s not something to be overlooked. We want to pay really close attention to it, want to make sure that we’re working with a provider that can help us tease through the nuances of these symptoms and then get on a plan that will actually help us monitor carbohydrates, watch very closely for insulin spikes, blood sugar spikes, and really get on a plan to make sure that we’re taking care of the total patient, not just a patient with elevated testosterone cause it’s a bigger picture than that.
14:46 I was, I said I was going to explain why testosterone and insulin are linked. Well, it goes something like this. When your blood sugar goes up, insulin goes up to bring the blood sugar down, say blood sugar, high blood sugars, very caustic to your system, a think of as like battery acid flowing through your veins. And that’s probably a poor analogy, but you get the picture, it’s very damaging to your organs and your blood vessels is what I’m trying to get to. And uh, when blood sugar stays up, insulin output goes up. There’s this organ in your body called the pancreas. It puts out insulin and it spikes the insulin to get the blood sugar down. Well, the more blood sugar issues you have, the more insulin we have to put out in order to get the cells to listen correctly so we can manage this blood sugar.
15:31 Over time, the pancreas loses the ability to keep up with the demand on the production for insulin and over time the sales become more and more insulin resistant. Well when that happens, a hormone called S H, BG or sex hormone-binding globulin, whose sole purpose is to control and put the brakes on the testosterone system or the androgen system, SHBG will go down. Well, when SHBG goes down, testosterone goes Willy nilly DHE goes Willy nilly and so as DHT. So those levels go up because insulin and blood sugar have gone up and that S H BG that regulating hormone has come down. So the way to stop that whole process is to make sure that we are eating a modified low carbohydrate diet. I’m not saying no carbs, I don’t agree with no carbs. I don’t believe in totally eliminating macros, but we do need to modify and watch cutting out simple things like corn and white potatoes and sugar and dairy and then any kind of sugary sweets and breads, wheat, those types of things that convert easily to sugar, like your body doesn’t know the difference when you ingest those things between the teaspoon of sugar and the food that you just put in.
16:50 So we have to monitor those things closely and get a really, really good handle on it. So I hope that helps understand the relationship between your hormones and your blood sugar and your insulin and vice versa. They’re all interlinked. And when we’re dealing with PCLs, it’s not as the name suggests and ovarian syndrome issue. It really and truly only 50% of women with PCLs have ovarian issues. It’s an insulin dysregulation disorder first and foremost, and it happens to cause ovarian issues and 50% of women. There’s actually a movement on the worldwide stage, not in the United States, but on the worldwide stage to rename, rename the disorder, because polycystic ovary syndrome is just a horrible name. It denotes that there are only problems with the ovaries and nothing could be further from the truth. So that wraps up this segment about elevated testosterone, the havoc that it can wreak the system and why we need to pay attention to it and how we can pay attention to it and what we can do to combat that.
17:52 If you’re listening in today, you’re a high achiever, you’re not feeling as good as you want to feel. Your energy’s low. You’ve had issues with PCLs type symptoms or high androgen, high testosterone type symptoms. You don’t quite know what to do. You may have even been told that it was elevated, but nobody did anything and you’re wanting to feel better. You actually want to move from great to great. I would love to craft a custom-tailored wellness plan for you. Let’s hop on a 15-minute strategy session. Go to Brian G brown.com. At the top of the page, you’ll actually see a link that says work with dr B. click on that link, fill out the application. It’s a short 23 question questionnaire and we’ll get the ball rolling. As soon as you get that application completed and back to us and we’ll, I’ll have my administrative assistant set up a time for us to talk. Otherwise, if you have any questions about this podcast episode, reach out to me on Facebook or Instagram at the optimal CEO. If you’re on LinkedIn, you could reach me at Dr. Brian G. Brown. I’d like to thank you for joining me today. Please tune in next time where I’m actually going to continue this talk about women’s hormones. We’re gonna actually talk about low testosterone next week and what that entails and what that means to women who have low testosterone. Until next time, this is Dr. Brian Brown, the optimal CEO signing off, and I hope you have an optimal day.
19:14 Here at The Optimal CEO Podcast, we help CEO entrepreneurs who love taking ownership of their wellness journey, but because they know it’s their most prized investment and when their state of wellness is at its peak, their income source. We want to help relieve CEO entrepreneurs from the pressure of unnecessary health exposure so they can be highly focused on growing their business and physically optimize for the journey so they can enjoy getting there.